Uterine fibroids: very common, often missed

Uterine fibroids are non-cancerous growths in the uterine muscle. They are extremely common - up to 80 percent of women develop them by age 50. Many cause no symptoms. Some cause very heavy periods, pelvic pressure, frequent urination, constipation, lower back pain, and pain during sex. Black women are diagnosed earlier, more often, and with larger fibroids - and historically have been undertreated.

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When fibroids matter

They cause symptoms (heavy bleeding, anemia, pressure, pain), interfere with fertility, or grow quickly. Asymptomatic small fibroids found incidentally usually do not need treatment.

Treatment options

Watchful waiting for asymptomatic. Hormonal contraception (especially hormonal IUD) reduces bleeding. Tranexamic acid (Lysteda) reduces bleeding during periods. GnRH agonists shrink fibroids short-term. Uterine artery embolization (UAE) shrinks fibroids without surgery, preserves uterus, faster recovery. Myomectomy (removing the fibroid, keeping the uterus) for women who want future fertility. Hysterectomy is curative but final.

What you can do besides medication

Iron + vitamin C if you are bleeding heavily. Treat for anemia early (do not wait until you crash). Track symptoms - this is the data your clinician needs to recommend a treatment level.

When to push for treatment

If you are missing days due to bleeding. If your ferritin is below 30. If pelvic pressure is daily. If sex is painful. If you are trying to conceive and have fibroids in the uterine cavity.

Common questions

Can fibroids turn into cancer? +

Rarely (less than 1 in 1000). Leiomyosarcoma is a separate cancer that grows fast - typical fibroids do not turn into it.

Do fibroids shrink after menopause? +

Usually yes, as estrogen drops. Postmenopausal bleeding from fibroids is still abnormal and needs evaluation.

Can I have a baby with fibroids? +

Many women do. Location and size matter. Fibroids in the uterine cavity can interfere with implantation - your clinician can advise on whether removal helps before trying.